In a research project in the Dominican Republic, Dr. John McLennan, of the Canadian Centre for Studies of Children at Risk, at McMaster University, in Hamilton, Ontario, found that Dominican mothers, asked why they ended breast-feeding early, gave responses similar to ones that many other researchers have found. But when they were also asked why mothers in the community ended breast-feeding, they reported "fear of loss of figure or of breast shape" and "not wanting to breast-feed" much more frequently.
These noticeable differences came to light when the Dominican mothers gave answers as to what they perceived for mothers in their community. Some of these "community" reasons have been much less frequently reported in other research studies, noted McLennan.
One of the differences had to do with the mothers' concerns about losing their body figure or breast shape. While not a single woman in the survey listed this as a reason of her own for stopping breast-feeding early, 29% of the women who had stopped breast-feeding in less in a year gave that answer as a "community" reason. McLennan noted that while this is a concern familiar to persons working directly with mothers and trying to encourage them to breast-feed, this is the first time that this reason has been reported in scientific literature as a possible factor influencing the duration of breast-feeding.
Up to this point, most studies looking at why new mothers stop breast-feeding have depended on mothers' reporting their own reasons for stopping, or the research has looked at such characteristics as the mother's age or the age of the child when bottle feeding was begun. While McLennan's research project asked mothers about their own practices and experience, including how long they had breast-fed and why they had stopped, the study also asked mothers how long women in their community breast-fed and why some stopped breast-feeding early. Asking these kinds of indirect questions, McLennan noted in his article, "may also identify reasons that are less socially acceptable and hence less likely to be elicited on self-report."
Other explanations for stopping breast-feeding early that were given much more often as "community" reasons included not wanting to breast-feed and not being able to breast-feed because the mother was working outside the home. McLennan carried out his research in Los Alcarrizos, a predominantly poor district on the outskirts of Santo Domingo, the capital of the Dominican Republic. His analysis was based on the results of interviews with 220 mothers.
The World Health Assembly in May 2001 recommended exclusive breastfeeding for the first six months of a child's life, changing a former recommendation that complementary foods should be given from four months of age onward. (The World Alliance for Breastfeeding Action has designated this week as World Breastfeeding Week, emphasizing the media's role in promoting and protecting breastfeeding to improve child health.)
The innovative approach in the Dominican Republic study could produce valuable new information, according to an editorial that accompanied the article. "To be able to design breast-feeding counseling programs, it's very important to understand the real reasons that cause many mothers to not breast-feed their children," said Dr. Rafael Pérez-Escamilla, a professor of nutrition sciences at the University of Connecticut who has researched and written extensively on breast-feeding, child nutrition and health.
The results could be applied to promote breast-feeding, McLennan said, with education and support efforts addressing both the "personal" and "community" reasons for ending breast-feeding early. One possibility might be to modify health promotion messages so they better stress breast-feeding benefits for the mother. The increasing numbers of women seeking employment outside the home may need better opportunities to breast-feed in the workplace. Making family planning services more available could also decrease the role of a new pregnancy in the early termination of breast-feeding.
The "Pan American Journal of Public Health," known in Spanish as the "Revista Panamericana de Salud Pública," is the leading scientific and technical publication of the Pan American Health Organization (PAHO). A monthly publication, it carries articles dealing with public health concerns throughout the Americas, in English, Spanish, and Portuguese. The article about breast-feeding, in English, appeared in the most recent issue, with an accompanying editorial, and both can be viewed and printed for free at the Internet site of the Pan American Health Organization (http://www.paho.org) by doing a search for the phrase "Dominican Republic breast-feeding".
PAHO, which was founded in 1902, works to improve health and raise living standards in all the countries of the Americas. It also serves as the Regional Office for the Americas of the World Health Organization.